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How AI is reshaping prior authorization

Top insights from Frost & Sullivan’s executive think tank

AI continues to drive fascinating conversations about the financial future of healthcare. With the introduction of so many new and emerging capabilities, it can be difficult to keep up.

That’s why consulting firm Frost & Sullivan recently held their Executive Think Tank Dinner, bringing together a selection of healthcare leaders to discuss the future of AI in RCM with a focus on prior authorizations. If you didn’t have the chance to attend, here are the top three takeaways.

1. Prior authorization pains and AI-powered solutions

A 2018 American Medical Association Survey revealed that 91% of physicians have seen prior authorizations delay necessary care for patients. The think tank participants discussed their options for handling the increase in volume and the challenges it presents.

Traditional solutions call for investment in more resources and support to document and maintain changing payer rules and workflows. But with the advent of AI, the discussion has turned to what many see as a more effective approach. Properly implemented and integrated, an AI-powered solution could deliver numerous benefits:

  • Reduced operational costs and denial rates
  • A reduction in manual work, allowing high-talent personnel to move to more challenging, rewarding roles
  • Shorter authorization cycles
  • A reduction in the need to reschedule patient treatments

2. Untangling the complexities of AI

While certain problems will be unique to each organization, integration of AI-powered solutions was seen as a universal concern. Participants agreed that successfully integrating an AI-powered solution hinges on a positive working relationship with the AI vendor, marked by clear and frequent communication, accurate timelines, and in-house expertise and support.

Another well-known concern is liability. If AI is making decisions, where does liability rest when things go wrong? With the software vendor, the hospital or the staff monitoring the solution? While there’s currently no one universally accepted opinion on the matter, driving the discussion concerning responsibility will continue to be a debate as AI usage grows.

3. Persistent pain points and the evolving patient financial experience

The group also took time to address the top RCM issues that were keeping them up at night. Denial management, reducing the cost to collect and dealing with the patient financial experience topped the list of pain points.

But while denial management and cost collection issues are familiar concerns, the patient financial experience continues to take on new complexities. Ensuring a positive experience has always been a priority for providers, but the changing healthcare landscape has begun to shift expectations and raise questions about financial responsibility. Although a positive clinical experience remains key, it’s now been established that a negative financial experience can play a key role in a patient’s decision to change providers or doubt the quality of the care they receive.

Final thoughts

Revenue cycle leaders must learn to take full advantage of AI to drive operational and financial progress, and prior authorizations are a logical place to start.

Want to learn more about how AI is shaping the future of healthcare? For a full look at the topics discussed at the think tank and even more takeaways, check out the whitepaper.


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